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Internal Affairs Te Tari Taiwhenua
BDM93B
Request for New Zealand Birth Certificate or Printout
He tono mo tetahi Tiwhikete Whanautanga o Aotearoa, Tanga ranei
You may be able to order your certificate and/or printout by phoning us.
Freephone 0800 22 52 52 (+64 4 463 9362 if outside New Zealand).
Do not use this form if your baby has not already been registered. If you have not registered your baby go to www.govt.nz/birth-registration
where you will also be able to order a certificate.
Step 1.
The birth certificate/printout I want (Fields with * must be completed)
* Surname ^
* First names ^
Place of birth (town or city) ^
* Date of birth (DD/MM/YYYY) ^
Parent 1 full name ^
Parent 1 full name at birth, if different from above ^
Parent 2 full name ^
Parent 2 full name at birth, if different from above ^
Other information (e.g. folio number) ^
Step 2.
Delivery Address.
If a standard certificate is ordered, it will be folded and the delivery name and address will appear on the back. If ordering certificates and printouts: the certificate will be posted to you and the printout will be emailed.
Delivery name ^
Flat number (if applicable) ^
Street number ^
Street ^
Suburb or rural locality ^
City, town or district ^
Postcode ^
Country (if not New Zealand) ^
Your daytime phone number ^
Your email address (If ordering a printout we will email it to you) ^
Step 3.
Certificates
A certificate is an official document containing registered information.
Standard certificates have a plain white background and no additional images.
Please indicate the number you need for each certificate design.
Standard & forest theme background - $55.00 per set ^
Standard & beach theme background - $55.00 per set ^
Standard background - $33.00 each ^
Forest background - $35.00 each ^
Beach background - $35.00 each ^
For a limited time only
‘All Blacks’ NZ birth certificate
Standard & All Blacks theme background - $55.00 per set ^
All Blacks background - $35.00 each ^
Printouts
A printout is a copy of the information from the registration and is not a legal document. Printouts are usually used for genealogical information purposes. A printout is either typed or a copy of the handwritten entry. Whether a typed or copy of the handwritten entry is issued depends on the record - this is not an option.
Please indicate the number you need for each printout.
Printout - $25.00 each ^
Courier fee (optional)
To a New Zealand address add $5.00 Yes or No ^
To an overseas address (contact us for details) Yes or No ^
If you intend to use the certificate overseas refer to www.dia.govt.nz/Document-authentication
Payment details DO NOT POST CASH
Total amount to pay $ ^
I enclose a New Zealand cheque, New Zealand money order
or international bankdraft in New Zealand dollars made out
to: The Department of Internal Affairs. Yes or No ^
Charge my credit/debit card (Do not post your card): Yes or No ^
VISA Yes or No ^
Mastercard Yes or No ^
Amex Yes or No ^
Prezzy Card Yes or No ^
Card number ^
Expiry date ^
Cardholder’s name ^
Cardholder’s signature ^
If paying in person at our Auckland, Manukau, Wellington or Christchurch office we also accept EFTPOS and cash payments.
If the record cannot be found we will contact you and search fees will apply.
Freephone 0800 22 77 77.
Phone +64 4 463 9362 (if outside New Zealand).
Warning: It is an offence, punishable by imprisonment and/or a fine of up to $10,000, to make a false statement to obtain a certificate, printout or a source document, or to provide any means of identification knowing that it is false or is suspected to be forged or falsified.
Steps 4 and 5 must be completed unless you are requesting a certificate/printout of a birth that occurred more than 100 years ago, or of a still-birth (this means the baby was not alive at birth) that occurred more than 50 years ago.
Step 4.
My declaration (the person ordering the certificate/printout must complete).
My Details
Surname ^
Surname at birth (if different from above) ^
First names ^
First names at birth (if different from above) ^
Place of birth (town or city) including country if not New Zealand ^
Date of birth (DD/MM/YYYY) ^
I declare that the information about me that is entered on this form is true and correct.
Signature ^
Date signed (DD/MM/YYYY) ^
If ordering on behalf of a company state their name below and include an original signed request on letterhead. ^
Your details or the company name will be entered in the Access Register. For information about the Access Register visit www.bdm.govt.nz.
Step 5.
Referee’s declaration (must be completed by another person who is 16 years of age or older).
I have known the orderer for at least 6 months or have seen a government issued photo identification of the orderer and I am 16 years of age or older – I am satisfied the information about the orderer’s identity stated in this form is true and correct.
Signature of referee ^
Date signed (DD/MM/YYYY) ^
Full name of referee ^
Phone number of referee ^
Contact address of referee ^
Step 6.
Before posting make sure step 5 is completed by any other person 16 years of age or older (even if you are ordering your own or a family members certificate).
Privacy Statement. The information on this form is collected under the Births, Deaths, Marriages, and Relationships Registration Act 1995. As part of processing your request, your identification details will be checked against other records held by Births, Deaths, Marriages and Citizenship or other government agencies, as authorised by law.
Post with fee to:
Certificate Team
Births, Deaths, Marriages and Citizenship
PO Box 10526
Wellington 6143
New Zealand
Last updated 9 June 2017